What is Functional Decline?

Functional decline is a new loss of independence in self-care capabilities and is typically associated with deterioration in mobility and in the performance of activities of daily living (ADLs) such as dressing, toileting, and bathing. When older adults are hospitalized, the medical illness causing hospitalization can cause a decline in functional status. Functional decline can also be caused by other factors related to hospitalization such as extended bed rest, reduced daily participation in ADLs, iatrogenic events, and inappropriate use of mobility-restricting devices such as indwelling catheters and intravenous lines.

Why is Functional Decline an Important Issue in Hospitals?

Functional Decline is a common problem in older people admitted to hospital:

30-60% of older people experience functional decline when acutely hospitalized1,2,3,4,5

One year after hospital discharge, less than 50% of older adults recover to their pre-illness level of functioning and rates of long-term care placement are high6,7

Processes of hospitalization may lead to Functional Decline:

It is estimated that up to 50% of older adults experience functional decline during hospitalization that is largely independent of their presenting medical illness4,8,9

Many factors related to processes across the hospital organization can contribute to functional decline

Factors Related to Hospitalization that Contribute to Functional Decline10

PC PROCESS OF CARE-RELATED FACTORS

Bedrest orders

Use of physical restraints

Mobility restricting devices such as indwelling catheters and intravenous lines/poles

Insufficient nutrition and hydration – extended use of NPO (no food by mouth) orders, diet not in keeping with patient preferences, inadequate access to water/fluids

Decreased patient participation in own ADLs

Polypharmacy, use of medications which can compromise activity/mobility (e.g. sleep medications, psychoactive medications)

Discharge planning occurs late

EB EMOTIONAL AND BEHAVIOURAL ENVIRONMENT FACTORS

Social deprivation – patient and family/caregiver participation not encouraged or optimized